Clinical Appeals RN

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

We currently seek an experienced RN with solid interpersonal skills to join our team. The chosen Clinical Appeals RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs, and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system

This is a telecommute, Monday - Friday position, standard business hours in the time zone that you reside, occasional overtime on an as needed basis.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Clinical Appeals (analyzing, reviewing appeals)
• Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
• Works with less structured, more complex issues
• Solves moderately complex problems and/or conducts moderately complex analyses
• Translates concepts into practice
• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Provides explanations and information to others on difficult issues

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Active, unrestricted RN licensure in your state of residence
• Ability to obtain additional state licenses as requested upon hire
• 3+ years of clinical experience in a hospital, acute care, or direct care setting
• Medical record review and/or appeal review experience
• Proficient in using Microsoft business applications and possess strong PC skills
• Access to high-speed internet from home

Preferred Qualifications:

• Utilization Management experience
• Prior Authorization Experience
• Medical Claim Review Experience
• Experience working in a managed care environment (insurance company or medical group)
• Knowledge of Medicaid regulations
• Knowledge ICUE
• Knowledge InterQual
• Demonstrated solid critical thinking, analytical and research skills
• Proven ability to adapt to change and work in a high-volume environment
• Ability to work until 7:00 PM Central Time

Careers with UnitedHealthcare. Work with a Fortune 5 organization that’s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.